84例上尿路结石梗阻性脓肾的腔内治疗

目的探讨腔内技术治疗上尿路结石梗阻性脓肾的临床疗效。方法回顾性分析84例上尿路结石梗阻性脓肾患者腔内治疗的临床资料,其中28例I期行经尿道输尿管镜取石术,56例I期先行微创经皮肾造瘘引流术,Ⅱ期行经皮肾镜取石术。结果 I期经尿道输尿管镜取石术的取净率92.9%,I期行微创经皮肾穿刺造瘘术+Ⅱ期微创经皮肾镜取石术的取净率89.1%。术中出现发热、寒战5例,均未出现感染性休克、大出血、脓肿播散及邻近脏器损伤等并发症。术后随访6～18个月,75例(89.3%)患肾功能不同程度的恢复,5例(6.0%)术后发生肾萎缩,3例(3.6%)肾盂肾炎,1例(1.2%)因感染无法控制行肾切除术。结论腔内技术治疗上尿路结石梗阻性脓肾创伤小、结石清除率高、并发症较少,可较好保护肾功能。

Endourological therapy for 84 cases of upper urinary tract calculous pyonephrosis

Objective To analyze the effect of endourological therapy for upper urinary tract calculous pyonephrosis.Methods Retrospective analysis was made of clinical data of 84 cases with upper urinary tract calculous pyonephrosis treated by endourological therapy.28 cases were treated by one-stage transurethral ureteroscopy,56 cases by one-stage mini-percutaneous nephrostomy and second stage pereutaneous nephrolithotomy.Results The stone free rate of one-stage mini-percutaneous nephrostomy was 92.9%,and 89.1% of onestage mini-percutaneous nephrostomy combined with second stage pereutaneous nephrolithotomy.Symptoms such fever,chill occurred in 5 cases during the surgery,while no septic shock,massive hemorrhage,abscess spread and damnification of adjacent organs occurred.All the patients were followed-up for 6 ～ 18 months.Renal function recovered to different degree in 75 out of 84 cases（89.3%）,5 cases atrophy kidney（6.0%）,3 cases pyelonephritis（3.6%）,1 case nephrectomy（1.2%） because of uncontrollable infection.Conclusion Endourological therapy for upper urinary tract calculous pyonephrosis has advantages of small trauma,high stone clearance rate,less complications,and can better protect renal function.